Infectious Tetanus Flashcards
Disease manifested by skeletal ms spasm and ANS disturbance
Tetanus
Tetanus is caused by
Clostridium tetani producing neurotoxin
Illness occurs in a child with normal ability to suck and cry in first 2 days of life but loses this ability in 3 and 28 d
Neonatal tetanus
Aerobic
G +
Spore forming rod
Highly resistant spore, resist boiling and disinfectant
Spores and bacilli survive in intestinal system
C tetani
C tetani toxin
Exotoxin tetanospasmin minimal lethal dose of 2.5 nanogram/kg
Tetanus transmission
Superficial abrasion to limb
Deeper infection severe and worse outcome
> 60 poor prognosis
Tetanospasmin MOA
retrograde transport in CNS
B toxin closely related in structure and function
Most common initial symptom
Trismus lockjaw
ms pain
Stiffness
Back pain
Difficulty of swallowing
Most common cause of death in tetanus
Respiratory failure
Autonomic disturbance CV, GI, renal failure felt at
2nd week of sx
Tetanus dx
clinical findings
culture is supportive
Poor prognosis
>70 Incubation of less than 7d Short time from first symptom to admission Period of onset <48 HR >140 SBP >140 Fever Severe spasm
Tetanus tx
Metronidazole 400mg rectally; 500mg IV q6 x 7d
Alternative drug
But
Penicillin
Aggravates spasm
TIG as antitoxin single IM DOSE
3000-5000 U
In the ER
spasm control with bzd
secure airway
CV instability inc sedation
Recovery 4-6w
Guideline for immunization
3 doses in infancy
Booster at 4-7, 12-15 and 1 adulthood (Tdap)
For unimmunized pregnant
2 doses at least 4 weeks apart
Clinically significant
Responsible for clinical manifestation
Tetanospasmin
Tetanospasmin affects the spinal inhibitory neuron
Renshaw cell
Neurotransmitters inhibited
GABA
glycine
Most common symptom in neonate
Poor suck
Inability to feed
Pathognomonic of tetanus sx
Opisthotonus
Risus sardonicus
Most common cause of neonatal tetanus
home delivery
obstetric complication - omphalitis
Penicillin is a
GABA antagonsist
similar with tetanospasmin
